This week, Smarter Digits in Healthcare is focusing on what’s working and what’s not with the ACA, through select data points (though, unfortunately, the most current data is often from 2014 or 2015). If you have additional data points to include, email us at firstname.lastname@example.org.
Whatever changes are legislated to the ACA, CMS, CMMI, MedPAC, etc will probably be phased in over the next 2 years, giving the healthcare machine time to adapt.
Of the 400 participants in the Medicare Shared Savings Program and Pioneer ACO Model in 2015, 31% received shared savings bonuses for 2015, up from 27% in 2014. While we’ve reported in the past that alternative payment plans were here to stay and providers needed to get onboard……well, we didn’t see TrumpCare coming. It’s impossible to say exactly what will happen to the ACA in the coming months and years, but the fundamental tenet of paying for higher quality will likely remain in tact.
Healthcare premiums for people getting coverage from the Federal marketplace are expected to rise roughly 25%. The increase is due in part to insurers underestimating their costs in prior years, so the increase is a market correction. And more likely it’s due to fewer insurers in the marketplace, expected to be 167, compared to 232 last year.
However, under ACA, quality of care has improved. Patient harms, including hospital-acquired conditions, pressure ulcers, central line associated infections, falls and traumas, are down 17% since 2014, and all-cause 30-day readmissions are down by an estimated 150,000 from January 2012 to December 2013.
Uncompensated care accounted for 5.3% of hospital costs in 2014, compared with 5.7% in 2013 and 6.1% in 2012. An estimated 68% of the savings was attributed to savings in Medicaid expansion states, and 32% to states without Medicaid expansion. We’re anxiously awaiting 2015 data, expected to be released by the AHA sometime this month. However, we’re not expecting a push to expand Medicaid in the remaining states given the uncertainty of the ACA.
Medicare trustees estimate that Medicare Part A will be solvent until 2028, after which point, the Federal government would need to allocate funds to cover a percentage of expenses. Before the passage of the Affordable Care Act, Part A was expected to be insolvent by 2017.